| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,119 |
12,068 |
$767K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,244 |
1,185 |
$572K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,658 |
2,383 |
$547K |
| D0330 |
Panoramic radiographic image |
9,352 |
9,301 |
$268K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
519 |
413 |
$245K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,723 |
7,492 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,176 |
2,176 |
$46K |
| D9430 |
|
1,188 |
1,164 |
$38K |
| D2952 |
|
343 |
298 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
547 |
545 |
$25K |
| D3320 |
|
47 |
45 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
387 |
383 |
$17K |
| D0270 |
|
3,122 |
3,095 |
$15K |
| D7230 |
|
58 |
37 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
53 |
$11K |
| D2160 |
|
25 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
89 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
83 |
$691.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$168.00 |
| D7953 |
|
186 |
167 |
$0.00 |
| D1310 |
|
284 |
283 |
$0.00 |
| D1330 |
|
273 |
270 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |